alterative influence, that vaccination destroys in the constitution the liabilisy to receive the poison of variola.

Dr. Faye sums up the result of investigations made by himself and others on this question as follows:

1. That vaccination, when duly performed, and followed by a negative result on a second trial, renders, in most cases, the constitution insusceptible of the poison of variola for the remainder of life, even when subjected to the influence of small-pox prevailing as an epidemic.

2. If variola does occur after a successful vaccination, its virulence will be in general greatly modified; but neither of the viruses gives absolute and certain immunity to variola during the individual's life. Vaccination should render the individual insusceptible of a second vaccination for a long period, if not for the entire duration of life-as, if it does not protect effectually against itself, it can hardly be expected to do so against the more potent poison of variola.

Dr. Faye then speaks of the requisites for a successful vaccination-viz., a good virus, its complete contact with the tissues, and the due susceptibility of the individual. In vaccination, however, we do not find that the immediate consequences of the punctures are a local inflammation; this does not occur till after the lapse of a certain period of time. Vaccine virus seems to cause a species of fermentation in the blood, while other matters act directly upon the locality to which they are applied. That such a fermentation really takes place is shown by the fact that, if you vaccinate afresh on the 12th or 13th day, a local inflammation with acuminated pustules shows itself within two days. If the vaccine pustule produces matter at too early a period, the result, as is known, will probably be unfavourable for the security of the patient. These questions are of particu lar interest in their bearing on the inoculation and operation of the syphilitic virus, hereafter to be considered.

Some individuals show themselves to be refractory to the vaccine virus; but Dr. Faye is of opinion that, if properly and fully introduced, there are very few constitutions that will resist its influence. No doubt, there is great difference in the powers of absorption in the skin in the amount of blood-vessels in each square inch of integument in individuals; but by inserting the virus deeper than ordinary, and ensuring thus its full contact with the tissues, Dr. Faye thinks a favourable result may almost always be ensured. From his experiments, he concludes that there really does exist a true immunity, not of the skin only, but of the constitution, produced by the vaccine virus; and that when fully performed, the individual is rendered insusceptible of a fresh zymotic disease of the same kind for a considerable length of time, if not for his whole life. It would be interesting, observes Dr, Faye, to ascertain whether any source of fallacy exists in our present mode of vaccination; and to what extent, and for how long a period, the inoculation of variolous matter alters the constitution, and renders it insusceptible of a second attack of small-pox.

We now come to the question of syphilization as compared to the effects of the vaccine virus on the system, and to which, by some of its advocates, it has been assimilated. In the first place, the venereal poison may be acquired by hereditary transmission, and in this it widely differs from vaccination; while it cannot, in all probability, be communicated through the medium of the atmosphere, as is unquestionably the case with small-pox. The primary and secondary forms of venereal disease preserve their specific character throughout; it is only in the tertiary and still more advanced forms that the type of syphilis seems to be more or less changed.

The experiments of Ricord, of Hunter, and of others, have satisfactorily shown that the matter of a primary chancre can with the greatest ease be inoculated, and that this inoculation is the best proof of the real character of the sore. According to Ricord, however, this virus is only inoculable for a certain period, which is often only of short duration; and the question then arises, whether such a sore, which has ceased to produce matter available for syphilitic inoculation, can yet give rise to syphilis under the ordinary contact of the mucous surfaces "in coitu." On this point, however, as on many others in regard to this important subject, great variety of opinion seems to prevail. Thiry of Brussels, and Ricord, hold that the chancre with indurated base is alone capable of

producing constitutional syphilis; while Sigmund of Vienna, an equal authority, does not admit of any specific character of ulcer as being alone capable of conveying the disease. Again, Professor Ricord holds that secondary syphilis cannot be transmitted by contagion, while a large array of authorities may be cited in favour of the contrary opinion. In Norway, the latter doctrine seems decidedly to be the prevailing one.

It has been proved with regard to primary syphilis that infection can be produced in the natural way from a chancre which has ceased to afford inoculable pus:

"The numerous inoculations of syphilitic virus which have been performed, both here in Christiania and elsewhere, and occasionally, too, on persons who never had had syphilis in their lives, have plainly shown that the local effects of the venereal poison can be transferred to various parts of the skin at one and the same time, and that chancres may be there produced without giving rise to any appreciable infection of the system, and certainly without producing the supposed characteristic induration of the base of the chancre, though the character of the local manifestation may vary according to the intensity of the virus employed, to the peculiarities of the skin, and to the individual tendency of the constitution to the elimination of morbid matter through this great secreting organ. According, however, to the statements of the syphilizers, there arises sooner or later a condition of the system wherein the skin shows itself insensible to any further inoculation of the chancre virus. As this immunity is considered to be equal to a perfect immunity of the system, we are constrained to admit that a chronic poison, such as that of syphilis certainly is, is circulating freely through the system without producing its usual injurious effects, and yet is bringing about a similar condition of the constitution to that occasioned by an acute zymotic disease such as small-pox, or the consequences of vaccination. We are to admit, in fact, that a fermenting of the poison, such as we consider as the result of small-pox or vaccine inoculation, here pervades the system, yet produces little or no irritative fever." (Faye, p. 30.)

True it is that such immunity may be only temporary-that the same individual, after the lapse of a certain time, may again be inoculated with positive results; but it is asserted that absolute impunity is at length obtained.

66

"If," says Professor Faye, we put together these statements, we come to the following singular conclusions:-That the poison of a primary chancre can yet infect in coitu, where it has ceased to be inoculable by the lancet; while on the other hand, the so-called inoculable virus can be propagated by inoculation for a longer or a shorter period, on the same individual, until the skin of this individual ceases to secrete a virus sufficiently active to affect itself again, though it may yet be efficient on the skin of another person. Again, virus taken from another person may in its turn possibly affect the supposed immune individual."

Professor Faye then considers the presumed immunity to the syphilitic poison to be fictitious; he regards it as only a temporary insensibility of the skin to further inoculations, and not as the consequence of an alterative change in the system, or of a presumed blood fermentation, such as is spoken of in regard to variola and vaccinia. He maintains that if the syphilitic virus be applied more deeply in the case of such individuals, by inserting it in larger quantities, and deep beneath the skin, where it comes more in contact with the blood, such inoculations will rarely be found to fail, and the presumed immunity disappears.

He brings forward a case in proof of this assertion from the practice of Dr. Vogt, one of the three members of the committee superintending the experiments on syphilization. The experiment was made with pus from an indurated chancre which had been tried in the ordinary way on eight different individuals, to the extent of sixty inoculations, but in all had failed, though these persons could be inoculated by other chancre matter. An incision was now made through the skin, instead of the ordinary slight scratch with the lancet, and the matter was inserted, and daily renewed, and the whole kept carefully bound up. This time the inoculation succeeded, and the matter was found to produce the specific sores when tried on others.

Professor Faye considers the poison of secondary syphilis to be weaker, but still of the same character, and subject to the same, though less manifest, conditions of propagation. He believes it to require more prolonged contact with the tissues, as where a syphilitic child infects a healthy nurse, and thus it is with greater difficulty inoculated by the lancet.

Two cases are given of secondary syphilis where Professor Faye experimented with a view to corroborate the above opinion, after both of them, mother and daughter, had been submitted to syphilization. Neither of these had taken mercury, but they had twice relapsed after a very short process of syphilization. In both there was great insensibility of the skin, and the chancres could not be further transmitted. The cases, therefore, cannot be regarded as complete as regards syphilization; for it has all along been observed, that where immunity is rapidly produced, the tendency to relapse is proportionately increased. Here, by deeper inoculation, chancres were again produced, and their character proved by transmission to other individuals, and by retro-transmission to the two persons above-mentioned.

So far, we think, though the experiments are incomplete and very few in number, Professor Faye has shown good grounds for doubting the value of the immunity so much insisted upon by the early syphilizers; but we should have been glad of more sustained proof, and of a greater array of cases to support his opinion.

From these few experiments he draws the conclusion that there is no such thing as the presumed immunity of the system to the venereal poison. He tells us that the external layers of the skin from prolonged inoculation, lose their vitality, and become more or less insensible to the virus, and little or no reaction is produced; the indurated chancre does not appear, and the sore that is formed is covered quickly with a scab, instead of progressing to suppuration. Still, if the virus employed be very intense, the usual results may yet occur, though the skin is ill suited, from the loss of its vitality, to reproducing virus for continuing the transmission. Here, however, Professor Faye neglects to tell us how it is that the whole skin becomes thus insensible to the venereal poison, for we should imagine that the local effects would be confined strictly to that part of the integument where the inoculations had been practised. We cannot see why the whole skin should lose its vitality from constant punctures made in the arms, thighs, and chest alone. It would have been well if Professor Faye had carefully satisfied himself on this point, and had given us an adequate explanation of the fact-if fact it be that under the process of syphilization applied to the above parts only, the whole of the integuments of other parts, as well as these, become insensible to the venereal poison. We confess this looks like some alterative change taking place through the blood, though, on physiological and pathological grounds, we should be inclined to refuse credence to such an opinion.

To return, however, to Professor Faye's conclusions: he tells us that should the virus, which has become inactive on one person, be transferred to another individual in whom there exists greater susceptiblity, and a greater tendency to elimination through that organ, we shall then find that it produces its full effect again. In a word, the susceptibility of the skin and the relative intensity of the virus will account for the gradations of difference in the supposed immunity, when the inoculations are performed in the usual superficial manner. Dr. Faye thinks that when the virus is introduced by a grooved needle into a subcutaneous canal, its intensity is much augmented by being thus cut off from air and light.

While Dr. Boeck, at the present day, does not regard immunity to all syphilitic virus as absolutely requisite, Dr. Faye, on the other hand, insists that it has a most important bearing on the whole question, and that if immunity be thrown aside, the whole fabric of the theory must fall, and we must seek elsewhere for an explanation of the success of the practice. In a word, the practice of syphilization will remain as an empirical method of treatment, and one quite inexplicable by our present knowledge of physiology and pathology. In saying this, Dr. Faye gives full testimony to the acknowledged fact that the secondary phenomena of constitutional syphilis have, in a great number of cases, disappeared under a course of syphilization-"at secundaere Phaenomener af constitutionel Syphilis i et stort Antal tilfaelde ere svundne under Syphilisationscuren" (p. 59) as far as the experience of the present time extends.

The variations that have been observed in the relations of immunity to the curative effects obtained by syphilization have been as follows:

1. In many cases the prevailing symptoms have disappeared before any immunity to the syphilitic virus had exhibited itself.

2. In other cases the disappearance of the symptoms coincided with the supervention of immunity.

3. In certain cases the secondary phenomena did not vanish even when immunity had been obtained; and this has been particularly observed in those instances where relapses have occurred.

"As far as I can see," continues Dr. Faye, "the curative inoculation of chancre virus loses by being deprived of its immunity, its most rational point of support, for then the method will, if considered as an alterative process carried on in the system, have to stand alone, without the aid of pathological science or physiological induction. No system of physiology or of pathology has as yet made us acquainted with a chronic zymosis, or blood-poisoning, which, under a constant re-introduction of the poison, operates in one case beneficially, and in another is followed by the most serious consequences." (p. 61.)

We see, then, that Professor Faye absolutely denies the existence of the supposed immunity to further infection, on which the earlier syphilizers laid so much stress. Among these we may reckon Dr. William Boeck himself, who certainly has contributed more than any other person to bring the subject under the notice of the profession in Norway; and to his latest observations we shall now briefly call the reader's attention. Two years of additional experience in the practice of syphilization seems only to have strengthened Dr. W. Boeck's confidence in this mode of treatment, and seems likewise to have induced him partially to moderate some of his theories. He does not hesitate to confess that the whole process by which syphilization cures constitutional syphilis is to him an enigma; but he still appeals to facts in confirmation of its efficacy. We must regard the practice, then, as purely empirical; but perhaps the same may be said with respect to the agency of quinine in the cure of intermittents. In the extensive resumé of his experience given at the end of the pamphlet which stands first upon our list, we have noticed some facts and observations which may be new to our readers, and which should be carefully compared with the opinions expressed by Dr. Boeck when we reviewed his former works in this Journal. As to the time that intervenes between the inoculation and the appearance of the pustule and chancre, Dr. Boeck says that it is generally only twenty-four hours, but in children a longer period is often required. Sometimes, even in adults, the chancre pustules are developed slowly; and occasionally there are exceptions to the rule that the earlier chancres are the most developed.

Great diversity is observed in the size of the chancres; those on the nates and thighs are usually the largest and deepest; and it has been observed that when inoculation has ceased to produce its effects on the arms and sides, large chancres still followed when the virus was introduced on the nates or thighs. This, at first sight, would seem to corroborate Professor Faye's opinion, that no constitutional alterative effect is produced by the inoculations; but the contrary is observed to be the case when the inoculations are first confined to the thighs, for then the virus is often found inefficient when it is subsequently introduced on the arms and sides. If this is really the case, we have here a strong proof of some real change being produced in the system beyond a mere local immunity from repeated irritation of the skin. Dr. Boeck has occasionally seen the chancres take on a phagedenic character; but in all instances this untoward symptom vanished speedily under continued syphilization.

The time required for the healing of the chancres varies considerably; they may disappear in a few weeks, or may continue open for months. It has been a subject of dispute as to whether the venereal poison varies in intensity, or whether its effects are only modified by the constitution of the individual. The former opinion is strenuously maintained by our author.

Subsequent to the publication of his former pamphlets, the prolonged discussion on Syphilization took place in the Christiania Medical Society. On reading carefully the reports of that discussion, it does seem to us that Dr. Boeck partially abandoned his great point of immunity; but in his present publication he evidently upholds it as strenuously as ever:

"In my earlier writings on Syphilization I considered immunity to be one of the most important points in the whole treatment, and with my further experience I have found no cause

for receding from this opinion. That under protracted inoculation of the syphilitic virus, the system finally becomes so insensible to the action of the poison, that you may introduce it with no more effect than would be produced by an equal quantity of water, is, in my opinion, a great physiological fact. The constitution of the individual after protracted inoculation assumes precisely the same position with regard to syphilis as we find in persons who have gone through measles, scarlatina, or small-pox, in respect to these exanthematous diseases. Against these last the constitution becomes effectually protected after an alterative process of a few days' duration; while in syphilis this only takes place after a long series of inoculations, but then this disease is in its nature essentially chronic." (p. 120.)

Here, then, we have Dr. Boeck's profession of faith unaltered, even after the rude onslaught made upon it by Professor Faye. We think, however, that, still more recently, he has somewhat modified his opinions in this regard. In his letter to the Medical Gazette, Sept. 19, 1857, he says "I will not engage in any strife as to the word immunity; I would only insist on this, that the body is brought into a new and healthier condition by these inoculations." Dr. Boeck is incredulous of Professor Faye having produced afresh inoculable chancres after an individual had once attained the desired immunity. He says, in a more recent communication, bearing date March, 1858, with which he has kindly favoured us, that the pustules thus produced do not forin regular chancres-that on the contrary, they crust over, dry up, and are abortive, healing from the periphery towards the centre, while the true chancre extends itself in a contrary direction.

"I will not, however," continues he, "hold to the word 'immunity,' but would use the following expressions of my opinions. That, by prolonged inoculation, there is developed a condition of the system which, in relation to the operation of the syphilitic poison, is altogether different from that which existed before syphilization was begun. Another question has been mixed up with that of immunity-viz., the question of its duration. To this I answer—1. I do not know if the same condition of the system which existed prior to syphilization will ever return, but I believe it will be a long time before it does so. 2. It is not long, however, before it is possible, by fresh inoculations, to produce small pustules and sores, and with these to effect a short series of inoculations, and the more distant the period is from that of the first syphilization the more numerous are the chancres, and the further can the series of inoculations be transmitted."

It would appear from these admissions that the immunity obtained by repeated syphilization is possibly not of long continuance, but on the other hand it is rather a remarkable fact as stated by Dr. Boeck at page 130 of this pamphlet, that of those individuals who had not been treated with mercury previous to syphilization (and their number amounts to more than a hundred) not one has come back to him with syphilis. It was not that these individuals had been leading unusually chaste lives (for many of them had taken gonorrhea), but it was as Dr. Boeck believes, because the syphilitic virus had little or no effect on their system when it was in contact with the mucous membranes. As comments on Professor Faye's experiments on syphilization, Dr. Boeck has turned his attention to the possibility of reproducing the vaccine pustule in children already vaccinated. In one case he operated on a child of three years on the 1st of May, and on the 8th there was a well-formed vaccine pustule on the arm, from whence he took matter and transferred it to the nates of the same child, when five out of the six punctures produced well-developed pustules, but on trying to transfer from these last to the arm and nates again the experiment failed. In his private communication to us, Dr. Boeck informs us, that besides the three published cases, he has since had one more case of relapse after syphilization, where the patient had not previously taken mercury.

Some further practical observations on the subject from the same source will interest

our readers

"1. The more the skin of the person to be syphilized is occupied by papular or pustular eruptions, the greater difficulty is experienced in inoculating, and the slower is the progress of the

cure.

"2. If measles come on in the process of syphilization, the symptoms of syphilis are increased and the cure is protracted